Rigid Thoracolumbar Orthosis Does Not Improve Outcomes of Acute Adolescent Spondylolysis as Compared With Placebo. Bony Union Predicts Improved Health-Related Quality of Life Outcomes at 2-Year Follow-Up.

STUDY

DESIGN

A prospective, comparative study on clinical, radiographic, and health-related quality of life (HRQoL) outcomes in adolescents with acute spondylolysis treated with a rigid thoracolumbar orthosis (Boston brace) or with a placebo (elastic lumbar support) with a 2-year follow-up time.

OBJECTIVE

To compare outcomes of acute adolescent spondylolysis treated with a rigid thoracolumbar orthosis or a placebo with a 2-year follow-up time.

BACKGROUND

The benefits of the use of rigid orthosis for the treatment of spondylolysis and achieving a bony union of spondylolysis remain unclear.

PATIENTS AND

METHODS

Sixty consecutive patients with acute spondylolysis were prospectively enrolled. Three patients were excluded from the analysis as they did not fulfil the inclusion criteria. The first 14 patients were randomized, and the remaining 46 chose the treatment method themselves. Treatment time was 4 months, and the follow-up time was 2 years. HRQoL was measured using the Scoliosis Research Society-24 (SRS-24) outcome questionnaire. The primary outcome was the HRQoL at 24 months and whether treatment type, bony union of the spondylolysis, or development of spondylolisthesis affected it.

RESULTS

Thirty (30/57) patients were treated with a Boston brace, and 27 (27/57) patients with a placebo. The bony union rate of spondylolysis did not differ between study groups (20/30 vs. 17/27, respectively, P = 0.789). The HRQoL did not differ between treatment groups in the SRS-24 domains through follow-up ( P > 0.05 for all). Five patients (5/57) developed spondylolisthesis (mean slip: 4.2 mm) during the 2-year follow-up time. Nonunion of the spondylolysis predicted the development of spondylolisthesis ( P = 0.005), but the treatment type did not affect it ( P > 0.05). Two years after treatment, patients who had bony union had higher SRS-24 total ( P = 0.005) and satisfaction domain ( P < 0.001) compared with patients with nonunion.

CONCLUSION

A rigid brace is not necessary for the treatment of acute spondylolysis. Achieving a bony union of adolescent spondylolysis is desirable as their HRQoL is higher at 2 years.

LEVEL OF EVIDENCE: Level II.